Normal distribution

Assessment of In-Office Tympanostomy Tube Insertion Tolerability in Children Under 2 Years

Objective: In-office tympanostomy tube insertion (TTI) is becoming more available in the practice of pediatric otolaryngology. This study evaluated the tolerability of this procedure in young children. Method: Four methods were used to assess tolerability. (1) Standardized video recordings were collected from 30 patients under 24 months who underwent in-office TTI with a single-pass insertion device with topical anesthesia alone. The videos were then reviewed by 3 independent experts in pediatric care and rated at 5 procedural time points using a defined response scale developed with the U.S. Food and Drug Administration. (2) Separately, overall tolerability was subjectively assessed by the same experts. (3) Patient recovery was assessed by the participating otolaryngologist and support staff. (4) Patient caregivers were surveyed for their impressions of the procedure, including whether they would recommend it to other caregivers. Results: In a total of 90 reviews, 100% of children were successfully treated and were rated as having acceptably tolerated the in-office tympanostomy tube procedure. All patients returned to an acceptable baseline without inappropriate crying and were assessed as fully recovered immediately following the procedure or by the time the child was leaving clinic. For caregivers, 93% agreed or strongly agreed that they would recommend the use of in-office TTI to other caregivers. Conclusions: In-office TTI in young children was determined to be universally well tolerated in young children and is a procedure that patient caregivers would recommend to other caregivers for their children. These results should help reassure otolaryngology specialists and caregivers alike that in-office ear tube placement is a viable option for young children with middle ear disease.

Effect of maneuvers, diuresis, and fluid administration on ultrasound-measured liver stiffness after Fontan

BACKGROUND

To determine the effect of stress maneuvers/interventions on ultrasound liver stiffness measurements (LSMs) in patients with Fontan circulation and healthy controls.

METHODS

In this prospective, IRB-approved study of 10 patients after Fontan palliation and 10 healthy controls, ultrasound 2D shear-wave elastography LSMs were acquired at baseline and after maximum inspiration, expiration, standing, handgrip, aerobic exercise, i.v. fluid (500 mL normal saline) administration, and i.v. furosemide (20 mg) administration. Absolute and percent change in LSM were compared between baseline and each maneuver, and then from fluid infusion to after diuresis.

RESULTS

Median ages were 25.5 and 26 years in the post-Fontan and control groups (p = 0.796). LSMs after Fontan were higher at baseline (2.6 vs. 1.3 m/s) and with all maneuvers compared to controls (all p < 0.001). Changes in LSM with maneuvers, exercise, fluid, or diuresis were not significant when compared to baseline in post-Fontan patients. LSM in controls increased with inspiration (+0.02 m/s, 1.6%, p = 0.03), standing (+0.07 m/s, 5.5%, p = 0.03), and fluid administration (+0.10 m/s, 7.8%, p = 0.002), and decreased 60 minutes after diuretic administration (-0.05 m/s, -3.9%, p = 0.01) compared to baseline. LSM after diuretic administration significantly decreased when compared to after i.v. fluid administration at 30 minutes (-0.79 m/s, -26.5%, p = 0.004) and 60 minutes (-0.78 m/s, -26.2%, p = 0.017) for patients after Fontan and controls at 15 minutes (-0.12 m/s, -8.70%, p = 0.002), 30 minutes (-0.15 m/s, -10.9%, p = 0.003), and 60 minutes (-0.1 m/s, -10.9%, p = 0.005).

CONCLUSIONS

LSM after Fontan is higher with more variability compared to controls. Diuresis is associated with significantly decreased liver stiffness in both patients after Fontan and controls, with the suggestion of a greater effect in Fontan patients.

A Systematic Review and Meta-Analysis of Synthetic Mesh Outcomes in Alloplastic Breast Reconstruction

Background

Mesh implants are frequently employed in alloplastic breast reconstruction. Notably, no mesh to date has FDA approval for this indication. Several synthetic meshes have been introduced with heterogeneous properties and outcomes.

Objectives

This study aims to systematically review synthetic mesh use in alloplastic breast reconstruction, describe rates of short-term complications, and analyze these outcomes in reports comparing synthetic and biologic meshes. The authors hypothesized data from comparative and noncomparative studies would show no significant differences between synthetic and biological meshes.

Methods

The authors conducted a systematic literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-one studies reporting the use of synthetic mesh and clinical outcomes were included. Eight studies directly comparing synthetic mesh and biological mesh were meta-analyzed for relative risk (RR). Nineteen noncomparative studies were analyzed for meta-rates. Outcomes, including seroma, infection, reoperation, and explant, were assessed on a per-breast basis. Resultant models were challenged for sensitivity and bias.

Results

Meta-analysis of comparative studies demonstrated no difference in the risk of infection with synthetic mesh (RR = 0.53; 95% CI [0.26-1.10]), but a reduced risk of reoperation (RR = 0.54; 95% CI [0.33-0.89]) or explant (RR = 0.43; 95% CI [0.21-0.87]). Meta-analysis of noncomparative studies demonstrated rates of seroma = 3%; 95% CI [1%-6%], infection = 4%; 95% CI [3%-6%], reoperation = 10%; 95% CI [7%-13%], and explant = 3%; 95% CI [2%-5%]).

Conclusions

Studies comparing synthetic and biologic meshes demonstrated noninferiority of synthetic in all outcomes assessed. Noncomparative studies demonstrated rates of seroma, infection, reoperation, and explant similar to literature values for biological mesh.

Level of Evidence 2 Risk

Valid and accurate simple equation to predict 3,000-m steeplechase performance

Introduction

Predict running performances is very important for athletes and trainers. Sport researchers have therefore developed certain tools to predict running performances, but only in non-obstacle races. This study aimed to develop and test the validity and accuracy of an equation for predicting 3,000-m steeplechase performance (PerfSteeple ).

Methods

The official rankings of French runners for the 3,000-m track-running (Perf3000 ) and 3,000-m steeplechase events were examined. Age, height and body mass were collected. From 146 included athletes, two groups were randomly composed: one comprising 80% of the sample (n = 117) to develop a simple equation to predict PerfSteeple (i.e., development group) and the other comprising the remaining 20% (n = 29) to test the validity and accuracy of the developed prediction equation (i.e., cross-validation group).

Results

The simple prediction equation included Perf3000 and age: P e r f S t e e p l e = - 57 , 165 + 1 , 147 × P e r f 3000 + 0 , 955 × a g e . No significant difference was noted between the actual and predicted performances. Predicted performances were significantly correlated with the actual ones, with a very high correlation coefficient (p < 0.001; r = 0.929). Bias and 95% limits of agreement were -5 ± 24 s, i.e., -0.8 ± 7.6%. In 95 of 100 new predictions, the difference between actual and predicted performance would be less or equal to-5 ± 24 s.

Discussion

The study confirms the validity and accuracy of the equation for predicting PerfSteeple . Predictions using this simple equation may be used in training and competitions for athletes and coaches. PerfSteeple  = -57,165 + 1,147 X Perf3000  + 0,955 X age.

Biceps tenotomy vs. tenodesis: an ACS-NSQIP analysis of postoperative outcomes and utilization trends

Background

While studies have assessed comparative rates of restoration of shoulder function and alleviation of symptoms, comparative systemic postoperative complication rates between biceps tenotomy and tenodesis have yet to be assessed. The purpose of the present study was to use a national administrative database to perform a comprehensive investigation into 30-day complication rates after biceps tenotomy versus tenodesis, thus providing valuable insights for informed decision-making by clinicians and patients regarding the optimal surgical approach for pathologies of the long head of the biceps tendon.

Methods

The National Surgical Quality Improvement Program database was queried to analyze postoperative complication rates and metrics associated with biceps tenotomy and tenodesis. Patient data spanning from 2012 to 2021 was extracted, with relevant variables assessed to identify and compare these two surgical approaches. Adjusted and unadjusted analyses were utilized to analyze patient demographics, comorbidities, operative times, lengths of stay, readmissions, adverse events, and yearly surgical volume, along with trends in usage, across cohorts.

Results

Of 11,527 total patients, 264 (2.29%), 6826 (59.22%), and 4437 (38.49%) underwent tenotomy, tenodesis with open repair, and tenodesis with arthroscopic repair, respectively. Tenotomy operative times ([mean ± SD]: 66.25 ± 44.76 minutes) were shorter than those for open tenodesis (78.83 ± 41.82) and arthroscopic tenodesis (75.98 ± 40.16). Conversely, tenotomy patients had longer hospital days (0.88 ± 4.86 days) relative to open tenodesis (.08 ± 1.55) and arthroscopic tenodesis (.12 ± 2.70). Multivariable logistic regression controlling for demographics and comorbidities demonstrated that patients undergoing tenodesis were less likely to be readmitted (adjusted odds ratio [AOR]: 0.42, 95% confidence interval [CI]: 0.17-0.98, P = .050) or sustain serious adverse events (AOR: 0.27, 95% CI: 0.13-0.57, P < .001), but equally likely to sustain minor adverse events (AOR: 0.87, CI: 0.21-3.68, P = .850), compared with patients undergoing tenotomy. Lastly, comparing utilization rates from 2012 to 2021 revealed a significant decrease in the proportion of tenotomy (from 6.2% to 1.0%) compared to open tenodesis (from 41.0% to 57.3%) and arthroscopic tenodesis (52.8% to 41.64%; P trend = .001).

Conclusion

To our knowledge, this is the first large national database study investigating postoperative complication rates between the various surgical treatments for pathologies of the long head of the biceps tendon. Our results suggest that tenodesis yields fewer serious adverse events and lower readmission rates than tenotomy. We also found a shorter operative time for tenotomy. These findings support the increased utilization of tenodesis relative to tenotomy in recent years.

Experimental study on physical exercise in diabetes: pathophysiology and therapeutic effects

Diabetes is a chronic disease. Some complications can be prevented, their effects can be slowed down.  Sedentary lifestyle increases the risk of obesity and consequently the predisposition to diabetes II. The article aimed to demonstrate the positive and negative effects of exercise on active and sedentary diabetics and on pathophysiology, evaluating the effects after 3 and 6 months. The study involved 90 participants, both male and female, with type II diabetes, aged 45, divided into two groups: Group A (n=50, sedentary) and Group B (n=40, active). We evaluated anthropometric parameters, blood chemistry values, which are fundamental for the transversal evaluation of the results. In group A improvements were less noticeable than group B. The most improved parameter is blood sugar, Glycemic values and BMI. Cholesterol and Hb1Ac decreased but more slowly than previous parameters. The expectations of the study were, not only in recognizing the therapeutic and preventive powers of exercise, but above all in choosing to program a motor protocol after a team work between diabetologist, sports doctor and kinesiologist and/ or personal trainer. Physical activity is an additional therapy to insulin.

Quantification of cell migration: metrics selection to model application

Cell migration plays an essential role in physiological and pathological states, such as immune response, tissue generation and tumor development. This phenomenon can occur spontaneously or it can be triggered by an external stimuli, including biochemical, mechanical, or electrical cues that induce or direct cells to migrate. The migratory response to these cues is foundational to several fields including neuroscience, cancer and regenerative medicine. Various platforms are available to qualitatively and quantitatively measure cell migration, making the measurements of cell motility straight-forward. Migratory behavior must be analyzed by multiple metrics and then models to connect the measurements to physiological meaning. This review will focus on describing and quantifying cell movement for individual cell migration.

The impact of a parent-based prevention intervention on Mexican-descent youths' perceptions of harm associated with drug use: Differential intervention effects for male and female youths

Parent training (PT) interventions reduce the likelihood of youth problematic behaviors, including drug use. However, the dissemination of culturally adapted PT interventions in low-income Latina/o immigrant communities remains scarce. In this selective prevention study, we examined the extent to which exposure to CAPAS-Youth, a culturally adapted version of the PT intervention known as GenerationPMTO^© , resulted in increased adolescent perception of harm associated with use of alcohol and other drugs. In a randomized controlled trial with 71 Latina/o immigrant families (95% of parents self-identified as Mexican origin, n = 98), 37 families were allocated to the CAPAS-Youth intervention condition versus wait-list control (n = 34 families). According to adolescents' reports at intervention completion, significant increased levels of perceived harm associated with drug use were found for female youths, but not for males. Differential results indicate the importance of tailoring PT prevention interventions according to youths' sex differences (i.e., males vs. females).

Sleep Stage Classification in Children Using Self-Attention and Gaussian Noise Data Augmentation

The analysis of sleep stages for children plays an important role in early diagnosis and treatment. This paper introduces our sleep stage classification method addressing the following two challenges: the first is the data imbalance problem, i.e., the highly skewed class distribution with underrepresented minority classes. For this, a Gaussian Noise Data Augmentation (GNDA) algorithm was applied to polysomnography recordings to seek the balance of data sizes for different sleep stages. The second challenge is the difficulty in identifying a minority class of sleep stages, given their short sleep duration and similarities to other stages in terms of EEG characteristics. To overcome this, we developed a DeConvolution- and Self-Attention-based Model (DCSAM) which can inverse the feature map of a hidden layer to the input space to extract local features and extract the correlations between all possible pairs of features to distinguish sleep stages. The results on our dataset show that DCSAM based on GNDA obtains an accuracy of 90.26% and a macro F1-score of 86.51% which are higher than those of our previous method. We also tested DCSAM on a well-known public dataset-Sleep-EDFX-to prove whether it is applicable to sleep data from adults. It achieves a comparable performance to state-of-the-art methods, especially accuracies of 91.77%, 92.54%, 94.73%, and 95.30% for six-stage, five-stage, four-stage, and three-stage classification, respectively. These results imply that our DCSAM based on GNDA has a great potential to offer performance improvements in various medical domains by considering the data imbalance problems and correlations among features in time series data.

Two Decades of Overuse and Underuse of Interventions for Primary and Secondary Prevention of Cardiovascular Diseases: A Systematic Review

Quality use of anti-hypertensive and cholesterol-lowering medications is crucial for successful cardiovascular disease management. This systematic review aimed to estimate levels of over and underuse of services for primary and secondary prevention of cardiovascular diseases from 2000 to 2020: overprescribing/underprescribing, overtesting/undertesting and overutilization/ underutilization of procedures compared to clinical practice guideline recommendations. Thirteen studies from USA, Europe, Asia and Australia were included. Wide practice variation was identified. Six studies reported overuse (eg, perioperative cardiac consultations, anti-hypertensive overprescribing for normotensive or pre-hypertensive people); and ten studies reported underuse (eg, under-prescribing of statins when indicated and under-screening for familial hypercholesterolemia). Lifestyle recommendations for cardiovascular disease prevention were largely underused. In summary, lack of adherence to published guidelines was prevalent over the past 2 decades for both primary and secondary prevention across settings. Further investigation of potentially justifiable deviations from guidelines are warranted to verify the estimates and identify points for intervention.

Renewable energy from secondary wood products contributes to local green development: the case of small-scale privately owned forests in Ciamis Regency, Indonesia

Background

Wood biomass from forests is a renewable energy source that has the potential to support global green development. However, the process of traditional firewood extraction and its contribution to the energy supply varies and is usually underrecognized, especially in the local context. Therefore, this study aimed to describe the traditional use and estimate the supply and demand for wood bioenergy from small-scale privately owned forests (SSPF) in Ciamis Regency, West Java Province, Indonesia.

Methods

The sample location was determined in 3 subdistricts, namely, Sukamantri, Ciamis, and Banjaranyar, which represent the northern, central, and southern regions, respectively. The data were collected through observations on stands, interviews with respondents, key informants from users and business actors of wood in the SSPF, and observations on the processes taking place in the flow and use of biomaterials and firewoods.

Results and conclusion

Firewood is a secondary product that cannot be separated from the main products along SSPF's chain of production based on the integration of raw material sources, linkages between actors, and volume sharing. The local knowledge and wisdom entanglements included the identification of the type and quality of firewood, distribution of resource allocation for household and industrial needs, and sharing of firewood for household needs. Although wood biomass contributes to the fulfillment of households and industrial needs of 8.51 million m3, there are indications of an imbalance between the potential supply and the demand for firewood due to its high intensity of use in industries. Therefore, multistakeholder and cross-regional support are needed to achieve sustainable SSPF management and fulfill the self-sufficiency of wood energy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13705-023-00383-7.

Choosing the appropriate measure of central tendency: mean, median, or mode?

Mean, median, and mode are among the most basic and consistently used measures of central tendency in statistical analysis and are crucial for simplifying data sets to a single value. However, there is a lack of understanding of when to use each metric and how various factors can impact these values. The aim of this article is to clarify some of the confusion related to each measure and explain how to select the appropriate metric for a given data set. The authors present this work as an educational resource, ensuring that these common statistical concepts are better understood throughout the Orthopedic research community.

Fewer daily steps are associated with greater cartilage oligomeric matrix protein response to loading post-ACL reconstruction

Aberrant joint loading contributes to the development of posttraumatic knee osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR); yet little is known about the association between joint loading due to daily walking and cartilage health post-ACLR. Accelerometer-based measures of daily steps and cadence (i.e., rate of steps/min) provide information regarding daily walking in a real-world setting. The purpose of this study was to determine the association between changes in serum cartilage oligomeric matrix protein (COMP; %∆COMP), a mechanosensitive biomarker that is associated with osteoarthritis progression, following a standardized walking protocol and daily walking in individuals with ACLR and uninjured controls. Daily walking was assessed over 7 days using an accelerometer worn on the right hip in 31 individuals with ACLR and 21 controls and quantified as mean steps/day and time spent in ≥100 steps/min. Serum COMP was measured before and following a 3000-step walking protocol at a preferred speed. %∆COMP was calculated as a change in COMP relative to the prewalking value. Linear regressions were used to examine associations between daily walking and %∆COMP after adjusting for preferred speed. Fewer daily steps (ΔR²  = 0.18, p = 0.02) and fewer minutes spent in ≥100 steps/min (ΔR²  = 0.16, p = 0.03) were associated with greater %∆COMP following walking in individuals with ACLR; no statistically significant associations existed in controls (daily steps: ΔR²  = 0.03, p = 0.47; time ≥100 steps/min: ΔR²  < 0.01, p = 0.81). Clinical significance: Individuals with ACLR who engage in less daily walking undergo greater %ΔCOMP, which may represent greater cartilage degradation or turnover in response to walking.

Early-Stage Detection of Ovarian Cancer Based on Clinical Data Using Machine Learning Approaches

One of the common types of cancer for women is ovarian cancer. Still, at present, there are no drug therapies that can properly cure this deadly disease. However, early-stage detection could boost the life expectancy of the patients. The main aim of this work is to apply machine learning models along with statistical methods to the clinical data obtained from 349 patient individuals to conduct predictive analytics for early diagnosis. In statistical analysis, Student’s t-test as well as log fold changes of two groups are used to find the significant blood biomarkers. Furthermore, a set of machine learning models including Random Forest (RF), Support Vector Machine (SVM), Decision Tree (DT), Extreme Gradient Boosting Machine (XGBoost), Logistic Regression (LR), Gradient Boosting Machine (GBM) and Light Gradient Boosting Machine (LGBM) are used to build classification models to stratify benign-vs.-malignant ovarian cancer patients. Both of the analysis techniques recognized that the serumsamples carbohydrate antigen 125, carbohydrate antigen 19-9, carcinoembryonic antigen and human epididymis protein 4 are the top-most significant biomarkers as well as neutrophil ratio, thrombocytocrit, hematocrit blood samples, alanine aminotransferase, calcium, indirect bilirubin, uric acid, natriumas as general chemistry tests. Moreover, the results from predictive analysis suggest that the machine learning models can classify malignant patients from benign patients with accuracy as good as 91%. Since generally, early-stage detection is not available, machine learning detection could play a significant role in cancer diagnosis.

Triple-negative breast cancer prevalence in Africa: a systematic review and meta-analysis

OBJECTIVE

The aggressive triple-negative breast cancer (TNBC) subtype disproportionately affects women of African ancestry across the diaspora, but its frequency across Africa has not been widely studied. This study seeks to estimate the frequency of TNBC among African populations.

DESIGN

Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

DATA SOURCES

PubMed, EMBASE, African Journals Online and Web of Science were searched on 25 April 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included studies that use breast cancer tissue samples from indigenous African women with sample size of eligible participants ≥40 and full receptor status for all three receptors (oestrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor receptor 2 (HER2)) reported.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and assessed risk of bias using the modified assessment tool by Hoy et al. (2012) for prevalence studies. A random-effects meta-analysis was performed, and data were pooled using the inverse-variance method and logit transformation. Pooled frequencies were reported with 95% CIs calculated with the Clopper-Pearson method and heterogeneity quantified with I² statistic. GRADE assessed the certainty of the evidence.

RESULTS

1808 potentially eligible studies were identified of which 67 were included in the systematic review and 60 were included in the meta- analysis. Pooled TNBC frequency across African countries represented was estimated to be 27.0%; 95% CI: 24.0% to 30.2%, I²=94%. Pooled TNBC frequency was highest across West Africa, 45.7% (n=15, 95% CI: 38.8% to 52.8%, I²=91%) and lowest in Central Africa, 14.9% (n=1, 95% CI: 8.9 % to 24.1%). Estimates for TNBC were higher for studies that used Allred guidelines for ER/PR status compared with American Society of Clinical Oncology(ASCO)/College of American Pathologists(CAP) guidelines, and for studies that used older versions of ASCO/CAP guidelines for assessing HER2 status. Certainty of evidence was assessed to be very low using GRADE approach.

CONCLUSION

TNBC frequency was variable with the highest frequency reported in West Africa. Greater emphasis should be placed on establishing protocols for assessing receptor status due to the variability among studies.

Impact of virtual vs. in-person interviews among neurosurgery residency applicants

BACKGROUND

The interview is considered a key factor in selecting residents in various medical and surgical specialties. However, the reliability of the interview process in selecting neurosurgery training program applicants remains largely under-investigated.

OBJECTIVE

To investigate the reliability of the interview process for neurosurgery residency applicants and to evaluate the impact of virtual interviews on this process.

METHODS

We analyzed the records of neurosurgery residency applicant interviews at our institution between 2016 and 2021. An average of 20 neurosurgery faculty members (clinical and research) interviewed each applicant and graded them 1 (best) to 4 (worst). Intraclass correlation coefficient (ICC) and Levene's test were used to assess the inter-rater and intra-rater reliability, respectively.

RESULTS

214 neurosurgery residency applicants were interviewed at a single institution between 2016 and 2021. The mean applicant rating each year ranged from 1.77 to 1.92. Inter-rater agreement was relatively poor in each year, (ICC < 0.5, P < 0.05). Among 60% of the raters, variability of scores significantly changed from year to year, (p < 0.05). When comparing the scores submitted during the virtual interview process (2021) with the scores submitted in the previous years (2016-2020), 2 interviewers (10%) had less variability using the virtual process.

CONCLUSION

Our analysis found that the current interview process for neurosurgery residency applicants' selection suffers from poor inter- and intra-rater reliability. Virtual interviews may be part of a cost-effective strategy to improve the reliability of the interview process. Further validation is needed, as well as identification of novel strategies to maximize the reliability of the selection process.

Effects of Electrical Stimulation of Acupoints on Xerostomia for Patients Who Undergo Hemodialysis

Xerostomia plays a major role in higher interdialytic weight gain (IDWG), which causes cardiovascular complications in patients who undergo hemodialysis. However, few studies have determined a method to manage xerostomia. This study determines the effect of transcutaneous electrical acupoint stimulation (TEAS) on hemodialysis patients with xerostomia and the percentage of IDWG. The study was a single-blind and quasi-experimental study. There are 75 participants: 37 in the TEAS group and 38 in the contrast group. The TEAS group used 250 µs and 50 Hz and the contrast group used 50 µs and 2 Hz three times a week for 3 weeks to stimulate ST 6 and TE17 acupoints. The salivary flow rates, dry mouth, and %IDWG were determined before, during and one week after the program. Compared with the contrast group, the TEAS group showed a significantly improved salivary flow rate (mL/min) (F (2, 123) = 15.28, p < 0.0001), and patients recovered their normal salivary flow rate. However, the results show that both groups showed significant improvement in dry mouth after treatment. The TEAS group demonstrated no effect in terms of %IDWG, as expected. The results show that a TEAS program is an effective means of symptom management for xerostomia patients who undergo hemodialysis. A TEAS program can be used to manage symptoms for xerostomia patients who undergo hemodialysis.

Nasal irrigation practice habits in infants: A Belgian survey: Nasal irrigation practice habits in infants

BACKGROUND

Nasal irrigation is widely used in infants to relieve nasal obstruction. However, the nasal irrigation technique has not been standardized, and nasal irrigation practice habits (NIPH) in infants have not been investigated. Our objective was to provide an overview of NIPH in infants among parents, childcare workers, and healthcare professionals living in Belgium.

METHODS

Parents, childcare workers, physiotherapists, nurses, pharmacists, and physicians were invited to fill in an electronic survey questioning their NIPH in infants. The survey was disseminated through social networks, practitioners' associations, and creches.

RESULTS

The questionnaire was fully completed by 359 participants. A ready-made solution was used by 93% of participants, of whom 92% used physiological saline. The prophylactic use of nasal irrigation was considered appropriate or very appropriate by 65% of all participants. The irrigation frequency was particularly heterogeneous among participants. The optimal solution propulsion speed and solution volume to be used depended on the group of participants being interviewed. At least 37% of parents and 20% of physicians did not take a stand on the optimal irrigation volume to use in each age category. On average, 83% of participants described performing nasal irrigation by lying the infant on one side and delivering the solution through the top nostril. Finally, 74% of respondents declared that no risk was associated with this technique.

CONCLUSION

Although some common NIPH viewpoints among the surveyed participants were identified, several disagreements were reported, reflecting the absence of a standardized method of nasal irrigation.

Effectiveness of the Infectious Disease (COVID-19) Simulation Module Program on Nursing Students: Disaster Nursing Scenarios

PURPOSE

This study aimed to develop an emerging infectious disease (COVID-19) simulation module for nursing students and verify its effectiveness.

METHODS

A one-group pretest-posttest quasi-experimental study was conducted with 78 under-graduate nursing students. A simulation module was developed based on the Jeffries simulation model. It consisted of pre-simulation lectures on disaster nursing including infectious disease pandemics, practice, and debriefings with serial tests. The scenarios contained pre-hospital settings, home visits, arrival to the emergency department, and follow-up home visits for rehabilitation.

RESULTS

Disaster preparedness showed a statistically significant improvement, as did competencies in disaster nursing. Confidence in disaster nursing increased, as did willingness to participate in disaster response. However, critical thinking did not show significant differences between time points, and neither did triage scores.

CONCLUSION

The developed simulation program targeting an infectious disease disaster positively impacts disaster preparedness, disaster nursing competency, and confidence in disaster nursing, among nursing students. Further studies are required to develop a high-fidelity module for nursing students and medical personnel. Based on the current pandemic, we suggest developing more scenarios with virtual reality simulations, as disaster simulation nursing education is required now more than ever.

Laboratory data clustering in defining population cohorts: Case study on metabolic indicators

The knowledge on the general population health is important for creating public policies and organization of medical services. However, personal data are often limited, and mathematical models are employed to achieve a general overview. Cluster analysis was used in this study to assess general trends in population health based on laboratory data. Metabolic indicators were chosen to test the model and define population cohorts. Data on blood analysis of 33,049 persons, namely the concentrations of glucose, total cholesterol, and triglycerides, were collected in a public health laboratory and used to define metabolic cohorts employing computational data clustering (CLARA method). The population was shown to be distributed in 3 clusters: persons with hypercholesterolemia with or without changes in the concentration of triglycerides or glucose, persons with reference or close to reference concentrations of all three analytes and persons with predominantly elevated all three parameters. Clustering of biochemical data, thus, is a useful statistical tool in defining population groups in respect to certain health aspect.

Physical Characteristics and Physical Fitness Profiles of Korean Taekwondo Athletes: A Systematic Review

This study aimed to present a standard and normal distribution of Taekwondo athletes’ physical characteristics and physical fitness profiles using a systematic review. A systematic search was conducted using four Korean databases (Research Information Sharing Service, National Digital Science Library, DBpia, and Korean Studies Information Service System). From 2010 to 2020, we reviewed 838 papers on Taekwondo athletes’ physical characteristics and physical fitness factors (e.g., body composition, muscle strength, muscular endurance, flexibility, cardiorespiratory fitness, power, agility, balance, speed, and reaction time). Of them, 24 papers were selected and analyzed. The criteria for selecting the physical characteristics and physical fitness factors for data extraction were set to have a total sample size of more than 30 individuals and included two or more studies. The sample size and average and standard deviation of physical characteristics and physical fitness factors were extracted from each selected study. In this study, the estimation error of all variables, except for the eyes-closed single-leg stance (15.71%), was less than 8%. Therefore, it was confirmed that there was no problem with the validity of the estimated values. These results could be used as an essential objective basis for evaluating the physical characteristics and physical fitness profiles of Taekwondo athletes in most countries worldwide and setting training goals.

Prediction of chemical compounds properties using a deep learning model

The discovery of new medications in a cost-effective manner has become the top priority for many pharmaceutical companies. Despite decades of innovation, many of their processes arguably remain relatively inefficient. One such process is the prediction of biological activity. This paper describes a new deep learning model, capable of conducting a preliminary screening of chemical compounds in-silico. The model has been constructed using a variation autoencoder to generate chemical compound fingerprints, which have been used to create a regression model to predict their LogD property and a classification model to predict binding in selected assays from the ChEMBL dataset. The conducted experiments demonstrate accurate prediction of the properties of chemical compounds only using structural definitions and also provide several opportunities to improve upon this model in the future.

Injury risk profile of amateur Irish women soccer players and players' opinions on risk factors and prevention strategies

OBJECTIVE

To explore injury profile, opinions on risk factors and injury prevention, among Irish amateur women soccer players.

DESIGN

A cross-sectional online survey.

SETTING

Irish amateur winter league.

PARTICIPANTS

Active players ≤18 years of age.

MAIN OUTCOMES

Differences were found between injured and uninjured groups, and risk factors that significantly predict soccer injury were identified.

RESULTS

168 injuries were reported by 83 respondents during the winter season. An increased prevalence of competition anxiety was observed in (53.8%:n = 85 of respondents) compared to other risk factors. There was a negative association between injuries and players' general health state (OR = 0.820, 95% CI 0.7-0.9, p = 0.007). Players' knowledge about some risk factors including playing position, joint hypermobility, and playing during menses contradicts current evidence. 50%; n = 67 of the respondents had not received any education on injury risk or prevention.

CONCLUSION

This study identified that Irish amateur women soccer players that responded have different characteristics, prevalence of risk factors and injury profiles to women players from different levels and countries. The findings suggest that some players may not be aware of the existing evidence base pertaining to common risk factors for injury. Further research is required to confirm the findings and explore the implementation of injury prevention strategies.

Is our urban water system still sustainable? A simple statistical test with complexity science insight

Sustainable development is being reconsidered as a process with unknown endpoint. Outputs of sustainable urban water systems defined as 'policies, projects, laws, technologies, and consumption and reuse amounts associated with urban water sustainability goals' are therefore being viewed as inadequate monitoring instruments. I propose a new methodology for sustainability monitoring whereby normality of a system is diagnosed through normality of its supporting inputs in lieu of normality of its complex outputs. Supporting inputs are 'intents and behaviors that support system goals'. Supporting inputs follow a principle of self-organization to remain in the norm and behavior zone commonly associated with system goals. This implies that normality of supporting inputs can be inferred from their longitudinally normal or Gaussian distribution that can be explored by significance tests; in particular, the Shapiro-Wilk test which is most powerful for n < 50. We identify fourteen supporting inputs of sustainable urban water systems - such as internet searches, community campaigns, staff training, agent-principal reporting and legislation propositions about water sustainability - and define quantitative indicators for them. The Shapiro-Wilk test and Kolmogorov-Smirnov test (K-S) of these indicators and a subsequent Boxplot outlying examination of non-normal indicators are undertaken in Yazd - a desert city in central Iran with a historic record in water conservation - in the light of its complex wastewater speculation. Qualitative examination of non-normal supporting inputs confirms the ability of our statistical methodology to detect problems in the system.

Socioeconomic Determinants of Health Contributing to the Consumption of Nonprescribed Medicines in Ethiopia

BACKGROUND

Social determinants of health are understood as the conditions in which people are born, grow, live, work, and age that shapes health and include a domain of factors. Self-medication is influenced by these socioeconomic factors. This study, aims to quantitatively examine the relationship between these factors and the use of nonprescribed medicines and then identify which of the factors have the highest predictable value in Ethiopia.

METHODS

A quantitative, descriptive, cross-sectional, community-based research approach was used to explore the relationship between the dependent and independent variables in Addis Ababa, Ethiopia. Descriptive statistics, cross-tabulations, bivariate and regression analysis were used in the analysis.

RESULTS

A total of 72.2% (n=433) participants were found to have an ever experience of self-medication in their life and 35.7%) (n=214) have the practice in the last two months. Bivariate analysis showed that in the predisposing factors categories: age group (50-59) (p-value=0.034); those who are knowledgeable about all drugs not to be given to nursing mother (p-value=0.006); those who agree on the attitude that they would rather treat themselves than go to the nearest health facility (p-value=0.000) in the enabling factors; those who were satisfied with their financial quality of life (p-value=0.014) and from the need factors; those who perceived their health status as good (p-value=0.000) showed a significant association. Multivariate analysis showed that age, knowledge, attitudes showed statistical significance. Also, quality of life satisfaction of enabling factors and illness in the past two months from need factors had a statistically significant effect as predictors of utilization of nonprescribed medicines.

CONCLUSION

To strategize for appropriate self-medication, interventions should focus on changing the knowledge, attitude, and perception of the specific sociodemographic factors identified in the study.

Renal length z-score for the detection of dysfunction in children with solitary functioning kidney

AIM

To evaluate whether renal length z-scores predict renal dysfunction in children with a solitary functioning kidney (SFK).

METHODS

In a single-centre retrospective cohort of children with SFK, we correlated body mass index z-scores, extracellular volume and lean body mass to renal length z-scores. We grouped these z-scores to other markers of renal dysfunction (proteinuria, hypertension, extracellular volume and abnormal estimated glomerular function rate [eGFR]) and analysed renal length z-score with multivariate analysis, receiver-operated characteristics (ROC) plots and Youden's index to determine an appropriate cut-off.

RESULTS

111 children had a median follow-up 5.08 years, eGFR 80.8 mL/min/1.73 m² , and age at last follow-up 7.4 (3.8-13.4 years). The median renal length z-scores of those without any renal dysfunction (n = 37, 25.1%) were greater (+3.66, interquartile range 3.02-4.47) than those with renal dysfunction (median 3.11, interquartile range 1.76-4.11, P = .0107, Mann-Whitney test). Using a cut-off of z-score of >+1.911, the odds ratio for having no renal dysfunction was 0.07 (95% CI 0.002-0.459, P = .0010). However, accuracy of the renal length z-score was poor (ROC curve 0.6488).

CONCLUSION

In this cohort of children with SKF, using the renal length z-score as a biomarker of renal dysfunction at 7 years of age is not recommended.

Higher procoagulatory potential but lower DIC score in COVID-19 ARDS patients compared to non-COVID-19 ARDS patients

BACKGROUND

COVID-19 is a novel viral disease. Severe courses may present as ARDS. Several publications report a high incidence of coagulation abnormalities in these patients. We aimed to compare coagulation and inflammation parameters in patients with ARDS due to SARS-CoV-2 infection versus patients with ARDS due to other causes.

METHODS

This retrospective study included intubated patients admitted with the diagnosis of ARDS to the ICU at Munich university hospital. 22 patients had confirmed SARS-CoV2-infection (COVID-19 group), 14 patients had bacterial or other viral pneumonia (control group). Demographic, clinical parameters and laboratory tests including coagulation parameters and thromboelastometry were analysed.

RESULTS

No differences were found in gender ratios, BMI, Horovitz quotients and haemoglobin values. The median SOFA score, serum lactate levels, renal function parameters (creatinine, urea) and all inflammation markers (IL-6, PCT, CRP) were lower in the COVID-19 group (all: p < 0.05). INR (p < 0.001) and antithrombin (p < 0.001) were higher in COVID-19 patients. D-dimer levels (p = 0.004) and consecutively the DIC score (p = 0.003) were lower in this group. In ExTEM®, Time-to-Twenty (TT20) was shorter in the COVID-19 group (p = 0.047), these patients also had higher FibTEM® MCF (p = 0.005). Further, these patients presented with elevated antigen and activity levels of von-Willebrand-Factor (VWF).

CONCLUSION

COVID-19 patients presented with higher coagulatory potential (shortened global clotting tests, increased viscoelastic and VWF parameters), while DIC scores were lower. An intensified anticoagulation regimen based on an individual risk assessment is advisable to avoid thromboembolic complications.

Effects of a 12-week structured circuit exercise program on physical fitness levels of children with autism spectrum condition and typically developing children

PURPOSE

This study aimed to determine the effects of a circuit exercise program on the physical fitness parameters of children with atypical autism spectrum condition (ASC) and typically developing (TD) children.

METHOD

Fourteen (14) boys with atypical autism (mean age: 10.07 ± 0.25 years; weight: 24.97 ± 0.64 kg; height: 126.79 ± 1.33 cm) and 14 typically developing boys (mean age: 10.07 ± 0.30 years; weight: 26.97 ± 0.55 kg; height: 126.50 ± 0.62 cm) participated in the study. The children were divided into four groups using a random coin toss: Autism Exercise Group (AEG), Autism Control Group (ACG), Typically Developing Exercise Group (TDEG), and Typically Developing Control Group (TDCG). Testing parameters from the Bruininks-Oseretsky test of gross motor proficiency (BOT-2) included running speed and agility, balance, bilateral coordination, and the standing long jump. Handgrip strength (both sides), reaction times (visual and auditory), and flexibility tests were also performed. The exercise program consisted of three 60-minute sessions per week for 12 weeks, using the most-to-least prompting method.

FINDINGS

Significant improvements were observed for AEG in running speed and agility, balance, standing long jump, reaction times, handgrip strength, and flexibility (p < 0.05). For TDEG, only the standing long jump scores failed to significantly improve (p < .05). Comparing AEG and TDEG pre- and post-test results, the former showed 30% greater development with respect to balance, standing long jump, auditory reaction time, and handgrip strength (p < 0.05).

CONCLUSION

Based on the significant improvements in physical fitness parameters of AEG, we recommend that children with ASC start sports training immediately when diagnosed with autism and participate in structured physical activities with their peers.

Assessing Stiffness, Joint Torque and ROM for Paretic and Non-Paretic Lower Limbs during the Subacute Phase of Stroke Using Lokomat Tools

The efficacy of Lokomat on motor recovery in stroke patients is well known. However, few studies have examined Lokomat tools to assess stiffness, joint torque and range of motion (ROM) during the subacute phase of stroke. The purpose of this retrospective observational study is to assess the changes of joint torque, ROM and stiffness that were estimated with Lokomat tools, namely L-FORCE (lower limb-force), L-ROM (lower limb-range of motion)and L-STIFF (lower limb-stiff), for paretic and non-paretic lower limbs in the subacute phase of stroke, assuming that the tools were able to measure these changes. The data come from 10 subjects in the subacute phase who had their first ever-stroke and followed a treatment that included Lokomat. The measurements came from basal assessments (T0) and one-month follow-up (T1). The measures were compared between paretic and non-paretic legs, and between T0 and T1. Significant differences in stiffness, joint torque and ROM were obtained between the paretic and non-paretic limbs at both T0 and T1. A non-significant trend was obtained for reduced stiffness and increased torque and ROM between T0 and T1 of the paretic limbs. The Lokomat tools were able to measure the changes between paretic and non-paretic legs and the small changes between T0 and T1 measurements.

Reverse versus anatomical shoulder arthroplasty in patients with intact rotator cuff

PURPOSE

The study objective was to compare the clinical results of reverse total shoulder arthroplasty (rTSA) and anatomical total shoulder arthroplasty (aTSA) in patients with osteoarthritis and intact rotator cuff. We hypothesised that the clinical results using rTSA would be comparable with those obtained with aTSA in this group of patients.

METHODS

The study included 51 patients with shoulder osteoarthritis and intact rotator cuff who underwent rTSA or aTSA. The range of motion, Constant-Murley score and strength in external rotation were recorded pre-operatively and at the two year follow-up. Subjective post-operative results were measured using the subjective shoulder value (SSV) score and a satisfaction questionnaire.

RESULTS

The post-operative improvement was significant in both groups, subjectively and concerning all parameters of the Constant-Murley score. Post-operatively, no significant difference was noted between the two groups for active anterior elevation (AAE), active external rotation (ER), internal rotation (IR) or Constant-Murley score (67 ± 12 in the rTSA group vs 71 ± 11 in the aTSA group). An exception was the Constant-Murley range of motion sub-score, which was better in the aTSA group (p = 0.028). No significant complications necessitating revision surgery were encountered.

DISCUSSION

Our findings are consistent with previous studies showing good results of rTSA with shoulder osteoarthritis and intact rotator cuff with a good restoration of the IR, similar to that obtained with aTSA.

CONCLUSION

The rTSA is a valid option for shoulder osteoarthritis and intact rotator cuff in older adult patients.

A systematic review of shock-attenuating componentry for lower limb amputees

BACKGROUND

Shock-attenuating pylons are commonly fitted to prostheses in order to compensate for the anatomical and biomechanical shock-absorbing features of the lower limb removed upon amputation. However, studies concerning their shock-attenuating capacity are highly variable and, to date, have not yet been reviewed, making them difficult to interpret and apply in clinical practice.

OBJECTIVES

To synthesise and appraise the available literature examining the effectiveness of shock-attenuating pylons in attenuating shock upon limb loading compared to rigid pylons among lower limb amputees.

STUDY DESIGN

Systematic review.

METHODS

A comprehensive search of seven databases was conducted using search terms concerning amputation level, shock-attenuating and rigid pylons as well as measures of shock attenuation. All studies yielded were screened against established inclusion and exclusion criteria before eligible articles were appraised using the Quality Assessment Standard for Crossover Studies adapted from the Cochrane handbook.

RESULTS

Nine articles were eligible for inclusion. While there was a trend among studies to indicate only a limited positive effect of shock-attenuating pylons in attenuating transient impact forces, limitations to the study designs, namely, in sampling, poor reporting of methodological details and heterogeneity of outcomes made conclusive interpretation of results difficult.

CONCLUSION

While the current body of literature does not reconcile with claims made by manufacturers of shock-attenuating pylons, it is insufficient to conclusively determine how effective shock-attenuating pylons are, in comparison with conventional rigid pylons, in attenuating transient impact forces among lower limb amputees. Higher quality research is required to better guide decisions regarding prescription of shock-attenuating componentry in clinical practice. Clinical relevance When delivered well, research can provide clinicians with objective and reliable data that can be applied in their practice to guide prescription of componentry. However, methodological limitations to research may compromise the reliability of findings, thereby producing potentially misleading outcomes. These limitations must be recognised and appreciated such that findings may be interpreted accurately and applied appropriately.